1,042 results on '"Clostridium Infections complications"'
Search Results
2. A case of community-acquired Clostridioides difficile infection causing intussusception, severe pneumonia, and severe hypokalemia.
- Author
-
Iwashita Y, Takeuchi S, Hadano Y, Kawamura T, Tanaka Y, Sato R, Kodani N, Yamada N, and Saito R
- Subjects
- Humans, Male, Aged, 80 and over, Pneumonia microbiology, Pneumonia complications, Japan, Anti-Bacterial Agents therapeutic use, Diarrhea microbiology, Diarrhea etiology, Clostridioides difficile isolation & purification, Community-Acquired Infections microbiology, Community-Acquired Infections complications, Clostridium Infections complications, Clostridium Infections microbiology, Hypokalemia etiology, Intussusception microbiology, Intussusception etiology
- Abstract
Background: Clostridioides difficile infection is associated with antibiotic use and manifests as diarrhea; however, emerging cases of fulminant diarrhea caused by binary toxin-producing C. difficile unrelated to prior antibiotic exposure have been reported. Although fulminant colitis caused by C. difficile has been documented, instances of intussusception remain scarce. Here, we present a case of adult intussusception with severe hypokalemia and pneumonia resulting from a community-acquired C. difficile infection in Japan., Case Presentation: An 82-year-old male presented with dizziness, progressive weakness, and diarrhea. Initial vital signs indicated severe respiratory and circulatory distress, and laboratory findings revealed hypokalemia, pneumonia, and septic shock. Imaging confirmed intussusception of the ascending colon. Although colonoscopy suggested a potential tumor, no malignancy was found. The C. difficile rapid test result was positive, indicating community-acquired C. difficile infection. Treatment with vancomycin was initiated; however, intussusception relapsed. Surgical intervention was successful and led to clinical improvement. The patient's complex pathophysiology involved community-acquired C. difficile-induced severe diarrhea, hypokalemia, hypermetabolic alkalosis, and subsequent intussusception. Although adult intussusception is uncommon, this case was uniquely linked to binary toxin-producing C. difficile. The identified strain, SUH1, belonged to a novel sequence type (ST1105) and clade 3, suggesting a highly virulent clone. Resistome analysis aligned with phenotypic susceptibility to metronidazole and vancomycin, confirming their treatment efficacy., Conclusion: This case report highlights a binary toxin-producing C. difficile that caused intussusception. The consideration of community-acquired C. difficile in the differential diagnosis of severe enteritis is necessary, even in Japan., (© 2024. The Author(s).)
- Published
- 2024
- Full Text
- View/download PDF
3. Clostridium paraputrificum Bacteremia in a Patient with Rectal Cancer after Receiving Antibiotic Therapy for Acute Pharyngolaryngitis.
- Author
-
Maeda Y, Miura R, Echizenya T, Hoshi K, Kubo N, Nakai H, Matsumoto K, Ikejima S, Kudo N, and Matsubara A
- Subjects
- Aged, 80 and over, Humans, Male, Acute Disease, Clostridium isolation & purification, Laryngitis drug therapy, Laryngitis microbiology, Laryngitis diagnosis, Pharyngitis drug therapy, Pharyngitis microbiology, Anti-Bacterial Agents adverse effects, Bacteremia drug therapy, Bacteremia microbiology, Bacteremia diagnosis, Clostridium Infections diagnosis, Clostridium Infections drug therapy, Clostridium Infections complications, Rectal Neoplasms drug therapy
- Abstract
Clostridium paraputrificum bacteremia is very rare, and its clinical importance is poorly understood. An 86-year-old man was receiving lascufloxacin therapy for acute pharyngolaryngitis before presenting to our emergency department with a recurrent fever. Two sets of blood cultures on admission revealed C. paraputrificum. A stool culture showed a reduced presence of intestinal commensal bacteria. After admission, the patient's fever resolved without antibiotics. Colonoscopy revealed a rectal tumor. Rectal tumor and microbial substitutions caused by antibiotics may have led to bacteremia. When treating C. paraputrificum bacteremia, physicians should be mindful of coexisting gastrointestinal disorders and a history of antibiotic administration.
- Published
- 2024
- Full Text
- View/download PDF
4. Clostridium perfringens -induced liver abscess with severe haemolysis.
- Author
-
Takanosu T, Izawa Y, Yonekawa C, and Mato T
- Subjects
- Humans, Male, Fatal Outcome, Aged, Clostridium perfringens, Clostridium Infections complications, Clostridium Infections diagnosis, Liver Abscess microbiology, Hemolysis
- Abstract
Clostridium perfringens is notorious for causing skin and soft tissue infections and food poisoning. Rarely, C. perfringens infections are associated with severe haemolysis, with a mortality rate of >80%. A previously healthy man in his 70s who presented with fever as his chief symptom was promptly admitted to a regional core hospital. Over the next 3 hours, shock and multiple organ failure ensued, leading to referral to our hospital for intensive care. We suspected a liver abscess caused by C. perfringens infection with haemolysis, findings of severe haemolysis and a liver mass with gas production that appeared within a few hours. Though surgical drainage was contemplated, low blood pressure resulted in death within 3 hours of arrival at our hospital. The next day, a blood culture confirmed C. perfringens , proving the diagnosis. Improving patient outcomes requires increased awareness of the disease and early detection., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2024
- Full Text
- View/download PDF
5. An Upper-Arm Clostridium perfringens Fracture-Related Infection: A Case Report.
- Author
-
Lamut A, Roškar S, Mihalič R, and Trebše R
- Subjects
- Humans, Anti-Bacterial Agents therapeutic use, Fractures, Bone surgery, Fractures, Bone complications, Fractures, Bone diagnostic imaging, Clostridium Infections complications, Clostridium perfringens isolation & purification
- Abstract
Conclusion: Fracture-related infections (FRI) pose serious complications, requiring swift surgical intervention. Although C. perfringens infections in FRIs are rare and literature is scarce, this case highlights the successful management and good functional outcome, offering valuable insights for clinicians dealing with such infections., Competing Interests: Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/C352)., (Copyright © 2024 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)
- Published
- 2024
- Full Text
- View/download PDF
6. Liver abscess caused by Clostridium perfringens leading to sepsis.
- Author
-
Yang H, Su X, Hao X, and Su B
- Subjects
- Humans, Male, Middle Aged, Clostridium perfringens isolation & purification, Liver Abscess microbiology, Liver Abscess etiology, Liver Abscess diagnostic imaging, Clostridium Infections complications, Sepsis microbiology, Sepsis etiology, Sepsis complications
- Published
- 2024
- Full Text
- View/download PDF
7. Primary clostridium difficile infection in patients with ulcerative colitis: Case report and literature review.
- Author
-
Gao X, Zhou H, Hu Z, Wang Q, Chen Y, Zh F, and Zhou G
- Subjects
- Male, Humans, Adult, Vancomycin therapeutic use, Infliximab therapeutic use, Anti-Bacterial Agents therapeutic use, Inflammation drug therapy, Colitis, Ulcerative drug therapy, Clostridioides difficile, Inflammatory Bowel Diseases complications, Clostridium Infections complications, Clostridium Infections diagnosis, Clostridium Infections drug therapy
- Abstract
Rationale: Inflammatory bowel disease (IBD), including Crohn disease (CD) and ulcerative colitis (UC), is a chronic immune-mediated disorder characterized by inflammation of the gastrointestinal tract. Patients with IBD are susceptible to various complications, including the coexistence of Clostridioides difficile infection (CDI). The incidence of IBD combined with difficile infection is higher in patients with compromised immune function, which can lead to increased mortality., Patient Concerns: A 43-year-old male presented with recurrent episodes of mucus and bloody stools persisting for more than a month without any identifiable triggering factors. Initially, the stool consistency was normal, but it progressively shifted to a loose and watery texture, with up to 8 occurrences daily., Diagnoses: This case underscores the diagnosis of severe UC through colonoscopy and colonic biopsy, along with the supplementary identification of a positive result for Clostridioides difficile in the fecal sample., Interventions: The patient initiated infliximab therapy alongside a full vancomycin course, demonstrating the potential effectiveness of this intervention in managing early-stage ulcerative colitis with concurrent Clostridioides difficile infection., Outcomes: Following the completion of a full vancomycin course, the patient initiated infliximab therapy. The patient was free from significant discomfort, exhibited no fever, and had no mucopurulent bloody stools. A follow-up blood test indicated reduced inflammatory markers compared to the preoperative period, and the stools were normal., Lessons: We illustrate the potential effectiveness of this medication by presenting an in-depth case report of a patient with early-stage UC. The report outlines the patient inclusion of infliximab to better manage UC inflammation alongside an adjunct vancomycin regimen, given the ineffectiveness of mesalazine therapy and the concurrent presence of Clostridium difficile infection. This case prompts consideration of therapeutic approaches for complex UC and contributes to advancing both research and clinical practice. Nonetheless, we should remain attentive to the variations and potential risks unique to each patient in order to formulate personalized treatment strategies., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2024
- Full Text
- View/download PDF
8. Current perspectives on fecal microbiota transplantation in inflammatory bowel disease.
- Author
-
Singh A, Midha V, Chauhan NS, and Sood A
- Subjects
- Humans, Fecal Microbiota Transplantation methods, Longitudinal Studies, Inflammation complications, Dysbiosis therapy, Treatment Outcome, Inflammatory Bowel Diseases therapy, Inflammatory Bowel Diseases complications, Clostridium Infections therapy, Clostridium Infections complications
- Abstract
Fecal microbiota transplantation (FMT) has emerged as a promising therapeutic modality within the domain of inflammatory bowel disease (IBD). While FMT has secured approval and demonstrated efficacy in addressing recurrent and refractory Clostridioides difficile infection, its application in IBD remains an area of active exploration and research. The current status of FMT in IBD reflects a nuanced landscape, with ongoing investigations delving into its effectiveness, safety and optimal implementation. Early-stage clinical trials and observational studies have provided insights into the potential of FMT to modulate the dysbiotic gut microbiota associated with IBD, aiming to mitigate inflammation and promote mucosal healing. However, considerable complexities persist, including variations in donor selection, treatment protocols and outcome assessments. Challenges in standardizing FMT protocols for IBD treatment are compounded by the dynamic nature of the gut microbiome and the heterogeneity of IBD itself. Despite these challenges, enthusiasm for FMT in IBD emanates from its capacity to address gut microbial dysbiosis, signifying a paradigm shift towards more comprehensive approaches in IBD management. As ongoing research progresses, an enhanced understanding of FMT's role in IBD therapy is anticipated. This article synthesizes the current status of FMT in IBD, elucidating the attendant challenges and aspiring towards the refinement of its application for improved patient outcomes., (© 2024. Indian Society of Gastroenterology.)
- Published
- 2024
- Full Text
- View/download PDF
9. Fecal microbiota transplantation for recurrent Clostridioides difficile infection in patients with concurrent ulcerative colitis.
- Author
-
Porcari S, Severino A, Rondinella D, Bibbò S, Quaranta G, Masucci L, Maida M, Scaldaferri F, Sanguinetti M, Gasbarrini A, Cammarota G, and Ianiro G
- Subjects
- Humans, Fecal Microbiota Transplantation adverse effects, Retrospective Studies, Cohort Studies, Recurrence, Treatment Outcome, Colitis, Ulcerative therapy, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections drug therapy, Inflammatory Bowel Diseases etiology
- Abstract
Aims: Clostridioides difficile infection (CDI) is a major challenge for healthcare systems. Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease, is a risk factor for primary and recurrent CDI (rCDI). Moreover, CDI itself often worsens the clinical picture of IBD, increasing the risk of complications. Fecal microbiota transplantation (FMT) is a highly effective treatment for rCDI, but data from patients with IBD and CDI are limited and often referred to mixed cohorts. We aimed to report outcomes from a cohort of patients with UC treated with FMT for rCDI superinfection., Methods and Results: In a retrospective, single-centre cohort study we evaluated characteristics and outcomes of patients with UC who received FMT for rCDI. The primary outcome was negative C. difficile toxin 8 weeks after FMT. Thirty-five patients were included in the analysis. Sixteen patients were cured after single FMT, while 19 patients received repeat FMT. Overall, FMT cured rCDI in 32 patients (91%), and repeat FMT was significantly associated with sustained cure of CDI compared with single FMT (84% vs 50%, p = 0.018). Twenty-four patients (69%) experienced remission or an amelioration of UC activity. Serious adverse events were not observed., Conclusions: In our cohort of patients with UC, FMT was highly effective in curing rCDI without severe adverse events and repeat FMT was significantly associated with CDI cure. Most patients also experienced remission or amelioration of UC activity after FMT. Our findings suggest that a sequential FMT protocol may be used routinely in patients with UC and rCDI., Competing Interests: Declaration of competing interest A.G. reports personal fees for consultancy from Eisai Srl, 3PSolutions, Real Time Meeting, Fondazione Istituto Danone, SinergieSrl, Board MRGE and Sanofi SpA personal fees for acting as a speaker for Takeda SpA, AbbVie and Sandoz SpA and personal fees for acting on advisory boards for VSL3 and Eisai. G.C. has received personal fees for acting as advisor for Ferring Therapeutics. G.I. has received personal fees for acting as speaker for Biocodex, Danone, Sofar, Malesci, Metagenics and Tillotts Pharma, and for acting as consultant and/or advisor for Ferring Therapeutics, Giuliani, Malesci and Tillotts Pharma. All other authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
10. Clostridioides difficile Infection in Pediatric Inflammatory Bowel Disease.
- Author
-
Reasoner SA and Nicholson MR
- Subjects
- Adult, Humans, Child, Fecal Microbiota Transplantation methods, Risk Factors, Clostridioides difficile, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases therapy, Clostridium Infections complications, Clostridium Infections diagnosis, Clostridium Infections epidemiology
- Abstract
Purpose of Review: Children with inflammatory bowel disease (IBD) are at increased risk of C. difficile infection (CDI) and experience worse outcomes associated with an infection. In this article, we review recent research on the incidence, diagnosis, complications, and treatment options for CDI in children with IBD., Recent Findings: Children with IBD have an elevated incidence of CDI, but their CDI risk does not associate with established risk factors in adults with IBD. Existing testing methodologies are inadequate at differentiating CDI from C. difficile colonization in children with IBD. Fecal microbiota transplantation offers a durable cure for recurrent CDI. CDI remains a frequent occurrence in children with IBD. Careful clinical monitoring should be used to diagnose CDI and patients with co-occurring IBD and CDI require careful surveillance for worse outcomes. Future research should explore the optimal diagnosis and treatment modalities in this unique patient population., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
11. Diarrhea don'ts: Reducing inappropriate stool cultures and ova and parasite testing for nosocomial diarrhea.
- Author
-
Garcia M, Krouss M, Talledo J, Alaiev D, Israilov S, Chandra K, Tsega S, Shin D, Zaurova M, Manchego PA, and Cho HJ
- Subjects
- Humans, Animals, Retrospective Studies, Diarrhea diagnosis, Diarrhea etiology, Hospitals, Feces, Parasites, Cross Infection diagnosis, Cross Infection prevention & control, Cross Infection complications, Clostridium Infections complications
- Abstract
Background: Diarrhea that develops in patients after 72 hours of hospitalization is likely to have a nosocomial or iatrogenic etiology. Testing with stool cultures and stool ova and parasites (O&P) is not recommended. Our goal was to reduce this inappropriate testing within a large, urban safety-net hospital system., Methods: This was a quality improvement project. We created a best practice advisory (BPA) within the electronic medical record that fires when a stool culture or O&P order is placed 72 hours after admission for any immunocompetent patient. It states that stool testing is low yield and offers the option to remove the order. We measured weekly counts of stool culture and stool O&P orders pre- and postintervention. We also measured the BPA acceptance rate, the 24-hour stool testing reorder rate, and Clostridioides difficile infection rates. Data were analyzed using Welch tests as well as a quasi-experimental pre- and postintervention interrupted time series regression analysis., Results: Stool culture orders decreased by 24.4% (P < .001). There was a significant level difference and slope difference with linear regression. Five of the 11 hospitals had a significant reduction in stool culture orders. Stool O&P orders decreased by 18.2% (P < .01). Three of the 11 hospitals had a significant reduction in stool O&P orders., Conclusions: Our intervention successfully reduced inappropriate stool testing within a large safety-net hospital system., (Copyright © 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
12. Recurrent Multidrug-Resistant Clostridium difficile Infection Secondary to Ulcerative Colitis a Case Report.
- Author
-
Jaramillo AP, Castells J, Ibrahimli S, and Siegel S
- Subjects
- Female, Humans, Mesalamine, Adalimumab, Anti-Bacterial Agents therapeutic use, Colitis, Ulcerative complications, Colitis, Ulcerative drug therapy, Clostridium Infections complications, Clostridium Infections drug therapy
- Abstract
IBD consists of two diseases-CD and UC-that affect the digestive tract, with a greater affinity for the large bowel. In this case report, we focus on one of its most common complications. CDI is a pathology that is mostly secondary to UC. Another cause of this bacterial infection is established after the use of antibiotics, most commonly at the hospital level. Around 20 percent of CDI persists because of a chronic dysbiosis of the microbiota and low levels of antibodies against CD toxins. In this case report, we demonstrated mdCDI in a young woman after treatment with multiple drug therapies as well as with semi-invasive procedures as follows: antibiotics (vancomycin, fidaxomicin), anti-inflammatory agents (mesalamine, sulfasalazine), corticosteroids (budesonide, prednisone), integrin receptor antagonists (vedolizumab), several semi-invasive procedures such as fecal transplant microbiota (FMT), aminosalicylates (5-ASA), treatment with tumor necrosis factor (TNF) blockers (adalimumab, golimumab), and immunomodulators (upadcitinib, tofacitinib). This leads us to establish how rCDI and its resistance to different treatments make this a challenge for the health system, both for hospitals and for outpatients, as well as how time-consuming each treatment is from the first intake of the drug until its total efficacy or until patients reach a dose-response and time-response to the disease. Accordingly, this case report and other similar cases reflect the need for randomized control trials or meta-analyses to establish therapeutic guidelines for cases of mdCDI in the near future.
- Published
- 2023
- Full Text
- View/download PDF
13. Upper mesenteric artery thrombosis as a complication of Clostridium difficile infection.
- Author
-
Mastroianni A, Vangeli V, Mauro MV, Manfredi R, and Greco S
- Subjects
- Humans, Mesenteric Arteries, Clostridium Infections complications, Clostridioides difficile, Gastrointestinal Diseases, Thrombosis diagnostic imaging, Thrombosis etiology
- Abstract
Competing Interests: Declaration of Competing Interest No conflict of interest to declare.
- Published
- 2023
- Full Text
- View/download PDF
14. A Case of Fatal Clostridium perfringens Sepsis with Massive Hemolysis in the Setting of a Coincidental Platelet Transfusion.
- Author
-
Boyd FA, O'Leary MF, Benson K, and Baluch A
- Subjects
- Female, Humans, Middle Aged, Clostridium perfringens, Hemolysis, Platelet Transfusion adverse effects, Blood Platelets, Fatal Outcome, Sepsis, Transfusion Reaction, Clostridium Infections complications, Clostridium Infections diagnosis, Clostridium Infections therapy
- Abstract
A 62-year-old woman with acute myeloid leukemia (AML) died of shock and massive hemolysis shortly after receiving two platelet transfusions at a routine clinic visit. Subsequent investigation into what was initially believed to be an acute hemolytic transfusion reaction secondary to platelet transfusions revealed that the patient died of Clostridium perfringens sepsis leading to massive hemolysis. Further investigation ruled out bacterially-contaminated platelets since a patient blood sample from 2 days prior had Clostridium species. The unusual findings and management considerations for this oncology patient are reviewed and compared with previously reported cases of C. perfringens transfusion-transmitted infections. Oncology patients may be especially susceptible to unusual presentations involving unusual pathogens., (© The Author(s) 2022. Published by Oxford University Press on behalf of American Society for Clinical Pathology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
- Full Text
- View/download PDF
15. The prevalence and clinical characteristics of Clostridium difficile infection in Saudi patients admitted with inflammatory bowel disease: A case-control study.
- Author
-
AlKhormi A, Altheyabi AM, AlGhamdi SA, Alshahrani O, Alotay AA, and Deeb A
- Subjects
- Adult, Humans, Case-Control Studies, Retrospective Studies, Prevalence, Saudi Arabia epidemiology, Risk Factors, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases epidemiology, Inflammatory Bowel Diseases drug therapy, Colitis, Ulcerative complications, Crohn Disease epidemiology, Clostridium Infections epidemiology, Clostridium Infections complications, Hypertension complications
- Abstract
Background: Inflammatory bowel disease (IBD) patients are at increased risk of Clostridium difficile infection (CDI), causing significant morbidity and mortality. This study examined CDI's prevalence, predisposing factors, and clinical outcomes in Saudi hospitalized IBD patients., Methods: : A retrospective case-control study was conducted at a tertiary medical city in Riyadh, Saudi Arabia. All Saudi adult patients with IBD, admitted over the preceding four years were identified from the hospital's database. Eligible patients were divided into those with CDI and those without CDI. Binary logistic regression was used to determine the predisposing factors for CDI among admitted IBD patients., Results: During the study period, 95 patients were admitted with IBD. Crohn's disease (CD) was the predominant type (71.6%), whereas 28.4% of the patients were with ulcerative colitis (UC). Only 16 (16.8%) patients had positive CDI. CDI-positive patients tend to have hypertension and previous use of steroids. Patients with UC tend to have a higher risk of CDI than those with CD. Most patients recovered from the CDI (81.3%) with a median time to CDI clearance of 14 days. Three patients (18.8%) had recurrent CDI; among them, one died., Conclusion: The prevalence of CDI in Saudi IBD patients is similar to that reported elsewhere. UC, steroid treatment, and hypertension are risk factors for CDI in IBD patients. Recurrence of CDI in IBD patients is common and associated with a poor prognosis., Competing Interests: None
- Published
- 2023
- Full Text
- View/download PDF
16. Concomitant Clostridioides difficile and Edwardsiella tarda Infection in a Patient with Ulcerative Colitis.
- Author
-
Fukuda H, Shinzaki S, Doi A, Yoshii S, Yoshioka T, Tsujii Y, Inoue T, Sakamori R, and Takehara T
- Subjects
- Female, Humans, Edwardsiella tarda, Clostridioides, Adrenal Cortex Hormones, Colitis, Ulcerative complications, Colitis, Ulcerative drug therapy, Colitis, Ulcerative diagnosis, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections diagnosis, Clostridium Infections drug therapy
- Abstract
Infectious enteritis is common in patients with inflammatory bowel disease (IBD). This case presented a young woman who underwent remission maintenance therapy for ulcerative colitis (UC). She was suspected of having concomitant Clostridioides difficile and Edwardsiella tarda infections. The patient's symptoms did not improve after initial antibiotic therapy; thus, the treatment strategy was modified to include an intravenous corticosteroid to treat the UC flare-up. Her symptoms significantly improved after corticosteroid administration. This is the first report of a case in which concomitant C. difficile and E. tarda infections occurred with UC flare-up.
- Published
- 2023
- Full Text
- View/download PDF
17. Impact of a multipronged approach to reduce the incidence of Clostridioides difficile infections in hospitalized patients.
- Author
-
Katzman M, Cohrs AC, Hnatuck PE, Greene WH, Reed SM, Ward MA, Glasser FD, Loser MF, and Hale CM
- Subjects
- Humans, Incidence, Feces, Immunoenzyme Techniques, Clostridioides difficile genetics, Bacterial Toxins analysis, Clostridium Infections epidemiology, Clostridium Infections prevention & control, Clostridium Infections complications
- Abstract
Background: Effective approaches to reduce Clostridioides difficile infections (CDI) in hospitalized patients are needed. We report data from 3 years preceding and 3 years following interventions that proved successful, with detailed analysis of all cases the first year after implementation., Methods: Interventions included a nursing protocol to identify cases present on admission by asking if the patient had 1 or more liquid stools in the last 24 hours, and a 2-step testing algorithm with samples positive by polymerase chain reaction (PCR) for the C. difficile toxin gene reflexing to an enzyme immunoassay (EIA) for the toxin antigen., Results: Healthcare-associated infections due to CDI fell from ∼160 in each of the preceding 3 years to <65 in each of the subsequent 3 years (P < .001), while the ratio of observed-to-expected hospital-onset cases diminished to ∼0.50 (P < .02). In the first year, 395 samples were PCR(+), but only 118 (29.9%) of these were EIA(+). 55 (46.6%) of the PCR(+)/EIA(+) samples were from hospital day 1 or 2 and classified as present on admission. The mean time from stool collection to report of PCR results was ∼7.5 hours, and the EIA took on average only 68 additional minutes to be reported., Conclusions: The number of incident CDI cases can be dramatically decreased by implementing an admission screening question and a 2-step testing algorithm., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
18. Clostridium difficile infection and immune checkpoint inhibitor-induced colitis in melanoma: 18 cases and a review of the literature.
- Author
-
Vuillamy C, Arnault JP, Fumery M, Mortier L, Monestier S, Mansard S, Bens G, Duval-Modeste AB, Funck-Brentano E, Jeudy G, Machet L, Chaby G, Dadban A, and Lok C
- Subjects
- Humans, Immune Checkpoint Inhibitors therapeutic use, Retrospective Studies, Melanoma complications, Melanoma drug therapy, Skin Neoplasms complications, Skin Neoplasms drug therapy, Colitis chemically induced, Colitis drug therapy, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases drug therapy, Inflammatory Bowel Diseases epidemiology, Clostridium Infections complications, Clostridium Infections drug therapy, Clostridium Infections epidemiology
- Abstract
Immunotherapy has become the standard of care for several types of cancer, such as melanoma. However, it can induce toxicity, including immune checkpoint inhibitor-induced colitis (CIC). CIC shares several clinical, histological, biological, and therapeutic features with inflammatory bowel disease (IBD). Clostridium difficile infection (CDI) can complicate the evolution of IBD. We aimed to characterize the association between CDI and CIC in patients treated with anti-CTLA-4 and anti-PD-1 for melanoma. Patients from nine centers treated with anti-CTLA-4 and anti-PD-1 for melanoma and presenting with CDI from 2010 to 2021 were included in this retrospective cohort. The primary endpoint was the occurrence of CIC. The secondary endpoints were findings allowing us to characterize CDI. Eighteen patients were included. Eleven were treated with anti-PD-1, four with anti-CTLA-4, and three with anti-PD-1 in combination with anti-CTLA-4. Among the 18 patients, six had isolated CDI and 12 had CIC and CDI. Among these 12 patients, eight had CIC complicated by CDI, three had concurrent CIC and CDI, and one had CDI followed by CIC. CDI was fulminant in three patients. Endoscopic and histological features did not specifically differentiate CDI from CIC. Nine of 11 patients required immunosuppressive therapy when CDI was associated with CIC. In nine cases, immunotherapy was discontinued due to digestive toxicity. CDI can be isolated or can complicate or reveal CIC. CDI in patients treated with immunotherapy shares many characteristics with CDI complicating IBD. Stool tests for Clostridium difficile should be carried out for all patients with diarrhea who are being treated with immunotherapy., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2023
- Full Text
- View/download PDF
19. Low prevalence of Clostridioides difficile infection in acute severe ulcerative colitis: A retrospective cohort study from northern India.
- Author
-
Mundhra S, Thomas D, Jain S, Sahu P, Vuyyuru S, Kumar P, Kante B, Panwar R, Sahni P, Chaudhry R, Das P, Makharia G, Kedia S, and Ahuja V
- Subjects
- Male, Humans, Young Adult, Adult, Middle Aged, Retrospective Studies, Prevalence, Steroids therapeutic use, Colectomy, Colitis, Ulcerative complications, Colitis, Ulcerative epidemiology, Colitis, Ulcerative drug therapy, Clostridium Infections epidemiology, Clostridium Infections complications, Clostridium Infections drug therapy
- Abstract
Background: The incidence of Clostridioides difficile infection (CDI) is high in ulcerative colitis and is associated with disease flares and adverse outcomes. However, the data on the dynamics of CDI in patients with acute severe ulcerative colitis (ASUC) is rather scarce. We evaluated the prevalence of CDI in patients with ASUC., Methods: This retrospective analysis of a prospectively maintained cohort admitted to the All India Institute of Medical Sciences, India, from May 2016 to December 2021, included patients with ASUC (as per Truelove and Witts criteria) who were tested for CDI. CDI testing was performed using enzyme-linked immunoassay for toxins A and B. Risk factors for developing CDI were analyzed along with short-term outcomes of ASUC. Steroid failure was defined as the need for medical rescue therapy or colectomy., Results: Total 153 patients with ASUC were included (mean age 34.92 ± 12.24 years; males 56.2%; disease duration 36 (IQR: 16-55.5) months, pancolitis 67.3%). Ninety-eight (63.4%), 72 (47%) and 10 (6.5%) patients, respectively, had received steroids, azathioprine and biologics in the past. Forty patients (26.14%) had a prior history of ASUC. Among risk factors for CDI, 14% of the patients had prior admission within 30 days, 22.2% had a recent history of antibiotics and 3.9% had long-term non-steroidal anti-inflammatory drug intake. Only one sample was positive for Clostridioides difficile toxin assay. Tissue Cytomegalovirus DNA-PCR positivity was noted in 57 patients (37.3%). Fifty-seven patients (37.3%) had steroid failure, 35 required medical rescue therapy and 30 (19.6%) required colectomy (eight after medical rescue therapy failure)., Conclusion: Despite antecedent risk factors for CDI, the overall prevalence of CDI in ASUC was low and the outcomes were determined by underlying disease severity., (© 2023. Indian Society of Gastroenterology.)
- Published
- 2023
- Full Text
- View/download PDF
20. An insight into the Clostridioides difficile infection-related diarrhea.
- Author
-
Hojati A
- Subjects
- Humans, Clostridioides difficile, Burns complications, Clostridium Infections complications, Diarrhea microbiology
- Abstract
Competing Interests: Conflict of interest The authors declare no competing interests.
- Published
- 2023
- Full Text
- View/download PDF
21. VE303, a Defined Bacterial Consortium, for Prevention of Recurrent Clostridioides difficile Infection: A Randomized Clinical Trial.
- Author
-
Louie T, Golan Y, Khanna S, Bobilev D, Erpelding N, Fratazzi C, Carini M, Menon R, Ruisi M, Norman JM, Faith JJ, Olle B, Li M, Silber JL, and Pardi DS
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents therapeutic use, Diarrhea etiology, Diarrhea microbiology, Diarrhea prevention & control, Diarrhea therapy, Feces chemistry, Feces microbiology, Gastrointestinal Microbiome, Recurrence, Reinfection prevention & control, Symbiosis, Treatment Outcome, Double-Blind Method, Bacterial Toxins analysis, Young Adult, Aged, Aged, 80 and over, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections microbiology, Clostridium Infections prevention & control, Clostridium Infections therapy, Probiotics administration & dosage, Probiotics therapeutic use
- Abstract
Importance: The effect of rationally defined nonpathogenic, nontoxigenic, commensal strains of Clostridia on prevention of Clostridioides difficile infection (CDI) is unknown., Objective: To determine the efficacy of VE303, a defined bacterial consortium of 8 strains of commensal Clostridia, in adults at high risk for CDI recurrence. The primary objective was to determine the recommended VE303 dosing for a phase 3 trial., Design, Setting, and Participants: Phase 2, randomized, double-blind, placebo-controlled, dose-ranging study conducted from February 2019 to September 2021 at 27 sites in the US and Canada. The study included 79 participants aged 18 years or older who were diagnosed with laboratory-confirmed CDI with 1 or more prior CDI episodes in the last 6 months and those with primary CDI at high risk for recurrence (defined as aged ≥75 years or ≥65 years with ≥1 risk factors: creatinine clearance <60 mL/min/1.73 m2, proton pump inhibitor use, remote [>6 months earlier] CDI history)., Interventions: Participants were randomly assigned to high-dose VE303 (8.0 × 109 colony-forming units [CFUs]) (n = 30), low-dose VE303 (1.6 × 109 CFUs) (n = 27), or placebo capsules (n = 22) orally once daily for 14 days., Main Outcomes and Measures: The primary efficacy end point was the proportion of participants with CDI recurrence at 8 weeks using a combined clinical and laboratory definition. The primary efficacy end point was analyzed in 3 prespecified analyses, using successively broader definitions for an on-study CDI recurrence: (1) diarrhea consistent with CDI plus a toxin-positive stool sample; (2) diarrhea consistent with CDI plus a toxin-positive, polymerase chain reaction-positive, or toxigenic culture-positive stool sample; and (3) diarrhea consistent with CDI plus laboratory confirmation or (in the absence of a stool sample) treatment with a CDI-targeted antibiotic., Results: Baseline characteristics were similar across the high-dose VE303 (n = 29; 1 additional participant excluded from efficacy analysis), low-dose VE303 (n = 27), and placebo (n = 22) groups. The participants' median age was 63.5 years (range, 24-96); 70.5% were female; and 1.3% were Asian, 1.3% Black, 2.6% Hispanic, and 96.2% White. CDI recurrence rates through week 8 (using the efficacy analysis 3 definition) were 13.8% (4/29) for high-dose VE303, 37.0% (10/27) for low-dose VE303, and 45.5% (10/22) for placebo (P = .006, high-dose VE303 vs placebo)., Conclusions and Relevance: Among adults with laboratory-confirmed CDI with 1 or more prior CDI episodes in the last 6 months and those with primary CDI at high risk for recurrence, high-dose VE303 prevented recurrent CDI compared with placebo. A larger, phase 3 study is needed to confirm these findings., Trial Registration: ClinicalTrials.gov Identifier: NCT03788434.
- Published
- 2023
- Full Text
- View/download PDF
22. An Unusual Cause of Acidosis in a Man With Clostridium difficile Colitis.
- Author
-
Oriot P, Aldersons E, and Rogghe PA
- Subjects
- Male, Humans, Clostridioides difficile, Enterocolitis, Pseudomembranous complications, Enterocolitis, Pseudomembranous diagnosis, Enterocolitis, Pseudomembranous drug therapy, Colitis complications, Colitis diagnosis, Acidosis, Clostridium Infections complications, Clostridium Infections diagnosis, Clostridium Infections drug therapy
- Published
- 2023
- Full Text
- View/download PDF
23. Gas gangrene caused by spontaneous Clostridium septicum infection: A case study.
- Author
-
Heino P, Schepel V, Malmi H, and Jahkola T
- Subjects
- Humans, Gas Gangrene diagnosis, Gas Gangrene etiology, Clostridium septicum, Clostridium Infections complications, Clostridium Infections diagnosis
- Abstract
Competing Interests: Declaration of competing interest The authors have no conflict of interest to declare.
- Published
- 2023
- Full Text
- View/download PDF
24. 60-year-old male with rapidly progressive pneumocephalus caused by Clostridium septicum in the setting of an occult colonic adenocarcinoma.
- Author
-
Helmink AJ, Wahlig TA, Fey PD, Chen J, and Foster KW
- Subjects
- Male, Humans, Middle Aged, Clostridium septicum, Clostridium Infections complications, Clostridium Infections diagnosis, Pneumocephalus complications, Colonic Neoplasms complications, Colonic Neoplasms diagnosis, Adenocarcinoma complications, Adenocarcinoma diagnosis
- Abstract
Background: Disseminated Clostridium septicum infection is an uncommon complication associated with malignancies, particular colonic adenocarcinoma. The organism appears to preferentially colonize large masses in rare individuals and subsequently seed the blood via mucosal ulceration. This has rarely been reported to lead to central nervous system infection and, in several cases, rapidly progressive pneumocephalus. In the few cases reported, this was a universally fatal condition. The current case adds to the reports of this extremely rare complication and provides a unique and complete clinicopathologic characterization with autopsy examination, microscopy, and molecular testing., Case Presentation: A 60-year-old man with no known past medical history was discovered having seizure-like activity and stroke-like symptoms. Blood cultures turned positive after six hours. Imaging revealed a large, irregular cecal mass as well as 1.4 cm collection of air in the left parietal lobe that progressed to over 7 cm within 8 h. By the following morning, the patient had lost all neurologic reflexes and died. Post-mortem examination revealed brain tissue with multiple grossly evident cystic spaces and intraparenchymal hemorrhage, while microscopic exam showed diffuse hypoxic-ischemic injury and gram-positive rods. Clostridium septicum was identified on blood cultures and was confirmed in paraffin embedded tissue from the brain by 16 S ribosomal sequencing and from the colon by C. septicum specific PCR., Conclusions: C. septicum is an anaerobic, gram-positive rod that can become invasive and is strongly associated with gastrointestinal pathology including colonic adenocarcinomas. Central nervous system infection with rapidly progressive pneumocephalus is a rarely reported and universally fatal complication of disseminated C. septicum infection., (© 2023. The Author(s).)
- Published
- 2023
- Full Text
- View/download PDF
25. Outcomes of clostridioides difficile infection on inflammatory bowel disease patients undergoing colonic resection: A propensity score weighted NSQIP analysis.
- Author
-
Connelly TM, Holubar SD, Clancy C, Cheong JY, Jia X, Bhama AR, Lightner AL, Kessler H, Valente M, and Liska D
- Subjects
- Humans, Propensity Score, Anti-Bacterial Agents therapeutic use, Postoperative Complications epidemiology, Risk Factors, Clostridioides difficile, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases surgery, Clostridium Infections complications, Clostridium Infections epidemiology, Clostridium Infections drug therapy, Crohn Disease
- Abstract
Background: Inflammatory bowel disease (IBD) patients are at risk for Clostridioides difficile infection (CDI). The majority of published outcomes data feature medically treated patients. We aimed to analyze outcomes in a large cohort of surgical IBD patients diagnosed with CDI., Methods: All patients with IBD in the ACS NSQIP Colectomy and Proctectomy (2015-2019) modules were identified. The IBD-CDI and IBD cohorts were propensity score weighted on demographic and surgical factors and compared., Results: In the entire unmatched cohort (n = 12,782), 119/0.93% patients were diagnosed with CDI (74.2% Crohn's/25.7% UC/Indeterminate colitis) within 30-days of surgery. After propensity score weighting, IBD-CDI was associated with increased risk of readmission (OR 4.55 [3.09-6.71], p < 0.001), reoperation (3.17 [1.81-5.52], p < 0.001) and any complication (2.16 [1.47-3.17], p < 0.001). Any SSI (2.58 [1.67-3.98]), organ space SSI (2.49 [1.51-4.11], both p < 0.001), prolonged ventilation (4.03 [1.39-11.69],p = 0.01), acute renal failure (15.06 [4.26-53.26],p < 0.001), stroke (12.36 [1.26-121.06],p = 0.03), sepsis (2.4 [1.39-4.15],p = 0.002) and septic shock (3.29 [1.36-7.96],p = 0.008) were also higher in the IBD-CDI cohort. Mean length of stay was increased by 39% in CDI patients., Conclusion: Post colonic resection, IBD-CDI patients have worse outcomes than IBD patients without CDI. These patients represent a particularly vulnerable cohort who require close monitoring for the development of postoperative complications., Competing Interests: Declaration of competing interest Tara M. Connelly MBBCh, FRCS, PhD: No disclosures, Stefan D. Holubar MD, MS, FACS, FASCRS: consulting fees, Shionogi, Takeda, Guidepoint; Funding: Crohn's and Colitis Foundation. Cillian Clancy FRCS, MD: No disclosures, Ju Yong Cheong MBBS, PhD: No disclosures, Xue Jia MD, MPH: No disclosures, Anuradha R. Bhama MD, FACS, FASCRS: No disclosures, Amy Lightner, MD, FACS, FASCRS: No disclosures, Hermann Kessler MD, PhD, FACS, FASCRS: No disclosures, Michael Valente DO, FACS, FASCRS: No disclosures, David Liska, MD, FACS, FASCRS: No disclosures. None., (Copyright © 2022 Elsevier Inc. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
26. Impact of Clostridioides difficile infection in patients admitted with ulcerative colitis.
- Author
-
Gros B, Soto P, Causse M, Marín S, Iglesias E, and Benítez JM
- Subjects
- Humans, Retrospective Studies, Aftercare, Patient Discharge, Colitis, Ulcerative epidemiology, Clostridioides difficile, Clostridium Infections epidemiology, Clostridium Infections complications
- Abstract
Background: Patients with ulcerative colitis (UC) are at increased risk of Clostridioides difficile infection (CDI), which is the principal causative agent of nosocomial diarrhoea in western countries. This has been related to complications such as need of colectomy and mortality among these patients. The aim of this study was to assess the incidence and impact of CDI in patients hospitalised with UC., Methods: Case-control retrospective study including patients admitted due to a UC flare from January 2000 to September 2018. Porpensity score matching (PSM) was performed to minimise selection bias taking into account the small number of cases compared to controls., Results: 339 patients were included; CDI in 35 (10.3%) patients. After PSM, 35 (33.33%) cases and 70 (66.67%) controls were analysed. Patients with CDI presented higher rates of readmission (52.9% vs. 21.4%, p = .001), increased mortality within the first 3 months post-discharge (5.9% vs. 0%, p = .042) and increased need of therapy intensification in the first year after admission (20.7% vs. 12.5%, p = .001). No risk factors for CDI were identified. Multivariable cox regression showed that treatment with 5-aminosalycilates at baseline (HR 0.42, 95% CI 0.18-0.92) and albumin <3.5 g/dL (HR 3.11, 95% CI 1.21-8.03) were associated with worse outcomes., Conclusions: CDI is a prevalent situation in hospitalised UC patients related to higher mortality within the first 3 months after the infection, need for therapy intensification within the first year and readmission. Our results underline the importance of CDI detection in patients with a flare of UC.
- Published
- 2023
- Full Text
- View/download PDF
27. Clinical outcomes for Clostridioides difficile associated diarrhea in inflammatory bowel disease patients versus non-IBD population: A retrospective cohort study.
- Author
-
Drozdinsky G, Atamna A, Banai H, Ben-Zvi H, Bishara J, and Eliakim-Raz N
- Subjects
- Adult, Humans, Male, Female, Retrospective Studies, Clostridioides, Risk Factors, Diarrhea epidemiology, Diarrhea complications, Recurrence, Clostridioides difficile, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases epidemiology, Inflammatory Bowel Diseases drug therapy, Clostridium Infections complications, Clostridium Infections drug therapy, Clostridium Infections epidemiology
- Abstract
Patients with inflammatory bowel disease (IBD) have a higher incidence of Clostridioides difficile infection (CDI). Previous studies have demonstrated negative clinical outcomes in IBD patients with CDI compared to patients without CDI. The clinical presentation of CDI is indistinguishable from IBD exacerbation, thus posing a frequent clinical dilemma on the role of Clostridioides infection in the testing, diagnosis, and treatment of these patients. To compare clinical outcomes of CDI in patients with IBD to those without IBD. Retrospective cohort of adult patients admitted to Rabin Medical Center Israel between the years 2014 and 2020 with a concurrent diagnosis of IBD and CDI. Matching 1:2 was performed between the IBD patients and the non-IBD population with respect to age and sex. Sixty-seven patients with IBD and 134 patients without IBD were included in the study. The groups' median age was 40.6 (interquartile range [IQR] of 29.8-68.9), with 45.8% male and 54.2% female. The non-IBD group had a higher Charlson score with 2 (IQR 0; 5) versus 0 (IQR 0; 4) in the IBD group (P value <.01). Patients with IBD had more exposure to systemic antibiotics, 71.1% versus 26.3% (P value <.01). In a multivariable analysis we found no difference in 90-day mortality and rate of relapse between the 2 study groups with an odds ratio of 1.709 (95% confidence interval 0.321-9.905) and odds ratio of 0.209 (95% confidence interval 0.055-1.513) respectively. In our cohort patients with IBD who present with diarrhea and concomitant CDI have similar rates of relapse and mortality compared with patients without IBD., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)
- Published
- 2023
- Full Text
- View/download PDF
28. Stool Interleukin-1β Differentiates Clostridioides difficile Infection (CDI) From Asymptomatic Carriage and Non-CDI Diarrhea.
- Author
-
Villafuerte Gálvez JA, Pollock NR, Alonso CD, Chen X, Xu H, Wang L, White N, Banz A, Miller M, Daugherty K, Gonzalez-Luna AJ, Barrett C, Sprague R, Garey KW, and Kelly CP
- Subjects
- Humans, Antitoxins, Bacterial Toxins, Enterotoxins, Immunoglobulin A, Immunoglobulin G, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections diagnosis, Clostridium Infections immunology, Diarrhea etiology, Feces chemistry, Interleukin-1beta
- Abstract
Background: Despite advances in the understanding and diagnosis of Clostridioides difficile infection (CDI), clinical distinction within the colonization-infection continuum remains an unmet need., Methods: By measuring stool cytokines and antitoxin antibodies in well-characterized cohorts of CDI (diarrhea, nucleic acid amplification test [NAAT] positive), non-CDI diarrhea (NCD; diarrhea, NAAT negative), asymptomatic carriers (ASC; no diarrhea, NAAT positive) and hospital controls (CON; no diarrhea, NAAT negative), we aim to discover novel biological markers to distinguish between these cohorts. We also explore the relationship of these stool cytokines and antitoxin antibody with stool toxin concentrations and disease severity., Results: Stool interleukin (IL) 1β, stool immunoglobulin A (IgA), and immunoglobulin G (IgG) anti-toxin A had higher (P < .0001) concentrations in CDI (n = 120) vs ASC (n = 43), whereas toxins A, B, and fecal calprotectin did not. Areas under the receiver operating characteristic curve (ROC-AUCs) for IL-1β, IgA, and IgG anti-toxin A were 0.88, 0.83, and 0.83, respectively. A multipredictor model including IL-1β and IgA anti-toxin A achieved an ROC-AUC of 0.93. Stool IL-1β concentrations were higher in CDI compared to NCD (n = 75) (P < .0001) and NCD + ASC+ CON (CON, n = 75) (P < .0001), with ROC-AUCs of 0.83 and 0.86, respectively. Stool IL-1β had positive correlations with toxins A (ρA = +0.55) and B (ρB = +0.49) in CDI (P < .0001) but not in ASC (P > .05)., Conclusions: Stool concentrations of the inflammasome pathway, proinflammatory cytokine IL-1β, can accurately differentiate CDI from asymptomatic carriage and NCD, making it a promising biomarker for CDI diagnosis. Significant positive correlations exist between stool toxins and stool IL-1β in CDI but not in asymptomatic carriers., Competing Interests: Potential conflicts of interest. C. D. A. has received grant support from Merck (investigator-initiated award, paid to institution); consulting fees for advisory board from Cidara Therapeutics, Merck, and Prime Meridian Group (on behalf of AiCuris); and honoraria for presentations from the American Society of Healthcare Pharmacists. A. B. reports being an employee of bioMérieux. M. M. reports being an employee of bioMérieux and a holder of patent (Susceptibility to C. difficile infection and Fecal Immunoglobulins; bioMérieux). C. P. K. has acted as a paid consultant to Artugen, Facile Therapeutics, Ferring, First Light Biosciences, Finch, Janssen (J&J), Milky Way Life Sciences, Pfizer, Seres, Summit, RVAC Medicines, and Vedanta; has received grant support from Milky Way Life Sciences; reports participation on a data and safety monitoring board or advisory board from Finch Therapeutics (payments to self); has served as Secretary (unpaid) for the Society for the Study of Celiac Disease; and holds stock or stock options from First Light. K. W. G. has received grant support paid to the University of Houston from Acurx, Summit, Paratek Pharmaceuticals, Tetraphase Pharmaceuticals, and Seres Health, and reports consulting fees from Acurx and Summit Pharmaceuticals. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
- Published
- 2023
- Full Text
- View/download PDF
29. Clinical significance and outcomes of Clostridium tertium bacteremia: analysis of 62 cases in neutropenic and non-neutropenic patients.
- Author
-
Kim H, Seo H, Park S, Chung H, Sung H, Kim MN, Bae S, Jung J, Kim MJ, Kim SH, Lee SO, Choi SH, Kim YS, and Chong YP
- Subjects
- Adult, Humans, Clinical Relevance, Retrospective Studies, Clostridium tertium, Clostridium Infections drug therapy, Clostridium Infections epidemiology, Clostridium Infections complications, Neutropenia complications, Neutropenia microbiology, Bacteremia drug therapy, Bacteremia epidemiology, Bacteremia etiology, Gastrointestinal Diseases, Hematologic Neoplasms complications, Peritonitis
- Abstract
The clinical significance of Clostridium tertium bacteremia is still uncertain. We evaluated the incidence, clinical characteristics, and outcomes of C. tertium bacteremia and identified differences between neutropenia and non-neutropenia. All adult patients with C. tertium bacteremia in a 2700-bed tertiary center between January 2004 and November 2021 were retrospectively enrolled. The first episode of C. tertium bacteremia in each patient was included in the analysis. Among 601 patients with Clostridium species bacteremia, 62 (10%) had C. tertium bacteremia, and of these 62 patients, 39 (63%) had had recent chemotherapy, and 31 (50%) had neutropenia or hematologic malignancy. C. tertium bacteremia originated frequently from a gastrointestinal tract infection such as enterocolitis (34%), primary bacteremia (29%), and secondary peritonitis (18%), and 34% of patients had polymicrobial bacteremia. Hematologic malignancy, prior antibiotic treatment, neutropenic enterocolitis, and primary bacteremia were significantly associated with C. tertium bacteremia in neutropenic patients, whereas solid tumor, hepatobiliary disease, secondary peritonitis, polymicrobial bacteremia, and a higher frequency of eradicable infection foci were significantly associated with C. tertium bacteremia in non-neutropenic patients. There was 15% 30-day mortality. APACHE II score (adjusted odds ratio [aOR], 1.5; 95% confidence interval [CI], 1.1-2.1) and secondary peritonitis (aOR, 25.9; 95% CI, 3.0-224.7) were independent risk factors for 30-day mortality. The prevalence of C. tertium bacteremia is low, and the characteristics of C. tertium bacteremia are significantly different between neutropenic and non-neutropenic patients. Appropriate investigation for gastrointestinal mucosal injury should be performed to improve treatment outcomes in this form of bacteremia., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2023
- Full Text
- View/download PDF
30. Clinicians, bear in mind a potentially fatal association: colorectal malignancy and Clostridium Septicum.
- Author
-
Portale G, Mazzeo A, Rettore C, Di Gregorio G, and Fiscon V
- Subjects
- Humans, Clostridium septicum, Colorectal Neoplasms, Colonic Neoplasms, Clostridium Infections complications, Gas Gangrene
- Published
- 2023
- Full Text
- View/download PDF
31. [Clostridium tertium bacteremia in patient with liver cirrhosis].
- Author
-
Lamberto Y, Huarachi-Chirilla Y, Dominguez C, Saul P, Chediack V, and Cunto E
- Subjects
- Male, Humans, Middle Aged, Liver Cirrhosis complications, Anti-Bacterial Agents therapeutic use, Clostridium tertium, Clostridium Infections complications, Clostridium Infections diagnosis, Bacteremia complications, Bacteremia diagnosis, Bacteremia drug therapy
- Abstract
Clostridium tertium is a bacterium of the Clostridiaceae family which can be found colonizing the gastrointestinal tract. Unlike other members of its family, it does not produce exotoxins. It was described for the first time in 1917 and in 1963 it was established as a pathogen in humans. Since then, cases have been reported mainly in immunosuppressed hosts, predominantly with primary focus at the abdominal level. The case of a 48-year-old man with a history of cirrhosis and hepatitis C virus infection is described. He presented an obstructed umbilical hernia that required intestinal resection and anastomosis, with positive blood and abdominal fluid cultures for Clostridium tertium. This case is of clinical importance due to the low prevalence of this germ, the possibility of resistance to usual antibiotic regimens and its sub diagnostic given the morphological and growth similarities with Bacillus or Lactobacillus.
- Published
- 2023
32. Inflammatory bowel disease is associated with increased complications after total knee arthroplasty.
- Author
-
Remily EA, Sax OC, Douglas SJ, Salib CG, Salem HS, Monárrez RG, and Delanois RE
- Subjects
- Humans, Risk Factors, Retrospective Studies, Arthroplasty, Replacement, Knee adverse effects, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases surgery, Colitis, Ulcerative complications, Colitis, Ulcerative surgery, Crohn Disease complications, Crohn Disease surgery, Clostridium Infections etiology, Clostridium Infections complications
- Abstract
Background: Few studies investigate the influence of inflammatory bowel disease (IBD) on complications following total knee arthroplasty (TKA). Therefore, we compared complications and readmissions frequencies after TKA in patients with Crohn's disease (CD) and ulcerative colitis (UC) to patients without IBD., Methods: A large administrative claims database was used to identify patients who underwent primary TKAs from 2010 to 2019 and had a diagnosis of IBD before TKA. Patients were stratified into two groups: those with CD (n = 8,369) and those with UC (n = 11,347). These patients were compared a control of 1.3 million patients without an IBD diagnosis. Chi-square and unadjusted odds ratios (OR) with 95% confidence intervals (CI) were used to compare complication frequencies. Multivariable logistic regression was used to evaluate independent risk factors for 90-day complications., Results: Compared to patients without IBD, patients with IBD were associated with higher unadjusted 90-day odds for Clostridium difficile infection (CDI) (CD: OR 2.81 [95% CI 2.17 to 3.63]; p < 0.001; UC: OR 3.01 [95% CI 2.43 to 3.72]; p < 0.001) and two-year periprosthetic joint infection (CD: OR 1.34 [95% CI 1.18 to 1.52]; p < 0.001; UC: OR 1.26 [95% CI 1.13 to 1.41]; p < 0.001). After controlling for risk factors like obesity, tobacco use, and diabetes, both types of IBD were associated with higher 90-day odds for CDI and PJI (p < 0.001 for all)., Conclusion: IBD is associated with higher 90-day postoperative CDI and PJI compared with patients without IBD. Providers should consider discussing these risks with patients who have a diagnosis of IBD., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: RED receives research support from member; Biocomposites, Inc.; CyMedica Orthopedics; DePuy Synthes Product, Inc.; Flexion Therapeutics; Microport Orthopedics, Inc.; Orthofix, Inc.;Patient-Centered Outcomes Research Institute (PCORI); Smith & Nephew; Stryker; Tissue Gene; and United Orthopedic Corporation; and is a board member of the Baltimore City Medical Society All other authors have nothing to disclose., (Copyright © 2022 Elsevier B.V. All rights reserved.)
- Published
- 2023
- Full Text
- View/download PDF
33. [A case of recurrent Clostridium difficile infection with type 2 diabetes mellitus indicating the usefulness of metformin hydrochloride].
- Author
-
Obata K and Yamashita S
- Subjects
- Female, Humans, Aged, Fidaxomicin therapeutic use, Metronidazole therapeutic use, Anti-Bacterial Agents therapeutic use, Diabetes Mellitus, Type 2 complications, Diabetes Mellitus, Type 2 drug therapy, Metformin therapeutic use, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections drug therapy
- Abstract
A 76-year-old woman undergoing insulin treatment for type 2 diabetes mellitus at our hospital was diagnosed with Clostridium difficile infection (CDI). She was treated with metronidazole, vancomycin hydrochloride, and fidaxomicin. Metformin hydrochloride in combination with fidaxomicin was administered to control the exacerbated symptoms. The diarrhea disappeared two days later, and colonoscopy confirmed the resolution of pseudomembranes eight days later. Till approximately two years after discharge, no recurrence was observed. Here metformin hydrochloride was suggested to be useful for the treatment of recurrent CDI with type 2 diabetes mellitus.
- Published
- 2023
- Full Text
- View/download PDF
34. Comparative analysis and trends in liver transplant hospitalizations with Clostridium difficile infections: A 10-year national cross-sectional study.
- Author
-
Ali H, Patel P, Pamarthy R, Fatakhova K, Bolick NL, and Satapathy SK
- Subjects
- Humans, United States epidemiology, Cross-Sectional Studies, Retrospective Studies, Hospitalization, Liver Transplantation adverse effects, Clostridioides difficile, Clostridium Infections complications
- Abstract
Goals and Background: Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated diarrhea in the United States. We aimed to determine comparative trends in inpatient outcomes of liver transplant (LT) patients based on CDI during hospitalizations., Methods: The national inpatient sample database was used to conduct the present retrospective study regarding CDI among the LT hospitalizations from 2009 to 2019. Primary outcomes included 10-year comparative trends of the length of stay (LOS) and mean inpatient charges (MIC). Secondary outcomes included comparative mortality and LT rejection trends., Results: There was a 14.05% decrease in CDI in LT hospitalizations over the study period (p = .05). The trend in LOS did not significantly vary (p = .9). MIC increased significantly over the last decade in LT hospitalizations with CDI (p < .001). LT hospitalizations of autoimmune etiology compared against non-autoimmune did not increase association with CDI, adjusted odds ratio (aOR) 0.97 (95% confidence interval [CI] 0.75-1.26, p = .87). CDI was associated with increased mortality in LT hospitalizations, aOR 1.84 (95% CI 1.52-2.24, p < .001). In-hospital mortality for LT hospitalizations with CDI decreased by 7.75% over the study period (p = .3). CDI increased transplant rejections, aOR 1.3 (95% CI 1.08-1.65, p < .001). There was a declining trend in transplant rejection for LT hospitalization with CDI from 5% to 3% over the study period (p = .0048)., Conclusion: CDI prevalence does not increase based on autoimmune LT etiology. It increases mortality in LT hospitalizations; however, trend for mortality and transplant rejections has been declining over the last decade., (© 2022 The Authors. Transplant Infectious Disease published by Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
35. Molecular epidemiology and clinical characteristics of Clostridioides difficile infection in patients with inflammatory bowel disease from a teaching hospital.
- Author
-
Li YM, Liao JZ, Jian ZJ, Li HL, Chen X, Liu QX, Liu PL, Wang ZQ, Liu X, Yan Q, and Liu WE
- Subjects
- Humans, Molecular Epidemiology, Multilocus Sequence Typing, Proton Pump Inhibitors pharmacology, Proton Pump Inhibitors therapeutic use, Hospitals, Teaching, Diarrhea, Anti-Bacterial Agents pharmacology, Clostridioides difficile genetics, Clostridium Infections complications, Clostridium Infections epidemiology, Clostridium Infections diagnosis, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases epidemiology, Anti-Infective Agents pharmacology
- Abstract
Background: Clostridioides difficile infection (CDI) in patients with inflammatory bowel disease (IBD) is of increasing concern. This study aimed to investigate the molecular epidemiology and antimicrobial susceptibilities of toxigenic C. difficile isolated from IBD patients and to evaluate the risk factors for CDI in IBD population., Methods: Loose or watery stools from IBD patients were tested for glutamate dehydrogenase, C. difficile toxins A&B and anaerobic culture. Toxigenic C. difficile isolates were characterized by multi-locus sequence typing, ribotyping and antimicrobial susceptibility testing., Results: The prevalence of CDI in IBD patients was 13.6% (43/317). The dominant sequence types (STs) were ST35 (20.9%), ST2 (18.6%) and ST37 (16.3%). The most common ribotypes (RTs) were RT 017 (18.6%), RT 012 (14.0%), and RT 220 (14.0%), whereas RT 027 and RT 078 were not detected in this study. All the isolates were susceptible to vancomycin and metronidazole. The multidrug resistance rate of C. difficile RT 017 was higher (p < 0.01) than that of other RT strains. Recent hospitalization, use of corticosteroids and proton pump inhibitors were related to increased risk of CDI in IBD patients; of these, recent hospitalization and proton pump inhibitors use were independent risk factors., Conclusion: Patients with IBD have a relatively high incidence rate of CDI. C. difficile RT 017 is most frequently isolated from IBD patients in this region and warrants more attention to its high resistance rate. Clinicians should pay greater attention to CDI testing in IBD patients with diarrhea to ensure early diagnosis and initiation of effective treatment., (© 2022 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.)
- Published
- 2022
- Full Text
- View/download PDF
36. Acute fulminant intravascular hemolysis induced by Clostridium perfringens in a symptomatic multiple myeloma patient under immuno-chemotherapy.
- Author
-
Yamamoto H, Mizutani Y, Iriyama C, Goto N, Okamoto A, Kato T, Shintani C, Yamamoto N, Miyama T, Mihara K, Okamoto M, and Tomita A
- Subjects
- Humans, Clostridium perfringens, Hemolysis, Immunotherapy, Multiple Myeloma complications, Multiple Myeloma drug therapy, Sepsis, Clostridium Infections complications
- Published
- 2022
- Full Text
- View/download PDF
37. Clostridium septicum brain abscess.
- Author
-
Tan DJA, Sng ECY, and Ling XW
- Subjects
- Female, Humans, Anti-Bacterial Agents therapeutic use, Abdominal Pain drug therapy, Clostridium septicum, Clostridium Infections complications, Clostridium Infections diagnosis, Clostridium Infections drug therapy, Brain Abscess diagnostic imaging, Brain Abscess drug therapy, Brain Abscess complications
- Abstract
We present a previously well woman in her 70s who was admitted for 2 weeks of progressively worsening abdominal pain, high fever and drowsiness. She was eventually diagnosed with Clostridium septicum brain abscess, meningoencephalitis and ventriculitis. The diagnosis was challenging as cerebrospinal fluid cultures were negative and a microbiological diagnosis was only obtained on brain biopsy. Despite early initiation of antibiotics that would have been effective against C. septicum , her central nervous system (CNS) infection progressed, and she eventually succumbed to the infection. Infections with C. septicum are typically fulminant and associated with high mortality. In a patient with a CNS infection and concomitant abdominal manifestations, infection with C. septicum should be considered., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2022
- Full Text
- View/download PDF
38. FMT: What's Next? A Narrative Review of Fecal Microbiota Transplantation in Clostridioides difficile Infection and Inflammatory Bowel Disease.
- Author
-
Patwa SA, Ward C, and Kelly CR
- Subjects
- Humans, Fecal Microbiota Transplantation adverse effects, Treatment Outcome, Chronic Disease, Clostridioides difficile, Clostridium Infections therapy, Clostridium Infections complications, Inflammatory Bowel Diseases therapy, Inflammatory Bowel Diseases complications
- Abstract
Fecal microbiota transplantation (FMT) is an increasingly employed treatment option for Clostridioides difficile infection (CDI), with growing data supporting its safety and effectiveness in patients with concurrent inflammatory bowel disease (IBD). Given that alterations in the gut microbiome are associated with both ulcerative colitis (UC) and Crohn's disease (CD), the use of FMT for the treatment of IBD itself is another area of active investigation. In this narrative review, we highlight the evidence for use of FMT in the treatment of CDI in patients with IBD, as well as for IBD alone, and provide insight into the future of microbiome therapeutics.
- Published
- 2022
39. Clostridium difficile infection risk in patients with hidradenitis suppurativa.
- Author
-
Sanghvi AP, Miles JA, and Sayed C
- Subjects
- Humans, Anti-Bacterial Agents therapeutic use, Risk Factors, Clostridioides difficile, Hidradenitis Suppurativa complications, Hidradenitis Suppurativa drug therapy, Clostridium Infections complications, Clostridium Infections epidemiology, Clostridium Infections drug therapy, Enterocolitis, Pseudomembranous chemically induced
- Abstract
Widespread use of antibiotics for hidradenitis suppurativa (HS) opens up the possibility of Clostridium difficile infection (CDI) and an increased risk of mortality. The purpose of this study was to identify risk factors for acquiring CDI in patients with HS. We suggest that providers should take risk factors including increased antibiotic class, hospitalizations, and advanced patient age into consideration when prescribing antibiotics for HS., (© 2022 British Association of Dermatologists.)
- Published
- 2022
- Full Text
- View/download PDF
40. Toxic Megacolon Due to Fulminant Clostridioides difficile Infection.
- Author
-
Bandaru SK
- Subjects
- Humans, Clostridioides difficile, Clostridium Infections complications, Megacolon, Toxic diagnostic imaging, Megacolon, Toxic etiology
- Published
- 2022
- Full Text
- View/download PDF
41. Clostridium subterminale infection in a patient with diffuse large B-cell lymphoma and haemophagocytic syndrome: A case report and literature review.
- Author
-
Zhou Y, Wang S, and Weng XB
- Subjects
- Clostridium genetics, Humans, RNA, Ribosomal, 16S genetics, Clostridium Infections complications, Lymphohistiocytosis, Hemophagocytic complications, Lymphoma, Large B-Cell, Diffuse complications
- Abstract
Although uncommon, infection caused by Clostridium subterminale may be life threatening particularly in immunocompromised patients. We report here a rare presentation of a patient with diffuse large B-cell lymphoma and haemophagocytic syndrome associated with C. subterminale bacteraemia. The management of the patient is described as well as a review of medical literature. Infection by Clostridium species, including C. subterminale, should be considered in a febrile patient with a haematologic malignancy. The case highlights the importance of using gene sequencing for identification of this anaerobic organism.
- Published
- 2022
- Full Text
- View/download PDF
42. Pediatric Reactive Arthritis Due to Clostridioides difficile Infection.
- Author
-
Rand K, Yau JT, He K, Mohandas S, Reyhan I, and Gutierrez Y
- Subjects
- Child, Humans, Arthritis, Reactive diagnosis, Arthritis, Reactive drug therapy, Arthritis, Reactive etiology, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections diagnosis, Clostridium Infections drug therapy
- Published
- 2022
- Full Text
- View/download PDF
43. Massive intravascular hemolysis is an important factor in Clostridium perfringens-induced bacteremia.
- Author
-
Suzaki A, Komine-Aizawa S, Nishiyama H, and Hayakawa S
- Subjects
- Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Clostridium perfringens, Hemolysis, Humans, Retrospective Studies, Bacteremia complications, Clostridium Infections complications, Clostridium Infections diagnosis
- Abstract
Clostridium perfringens bacteremia is rare but often fatal. In particular, once bacteremia with massive intravascular hemolysis (MIH) occurs, the mortality rate is extremely high. However, because of its rarity, the detailed pathophysiology of this fulminant form of bacteremia is unclear. To elucidate the detailed pathogenesis of MIH, we retrospectively reviewed the data of all patients with C. perfringens bacteremia from two university hospitals from 2000 to 2014. The medical records and laboratory data of 60 patients with bacteremia, including 6 patients with MIH and 54 patients without MIH, were analyzed. Patients with MIH had higher rates of intense pain at onset, impaired consciousness, shock at presentation, hematuria, metabolic acidosis, and gas formation than patients without MIH. The antibiotic susceptibility of the clinical isolates was not significantly different between the two groups. All patients with MIH, although treated with appropriate antimicrobial agents, died within 26 h of admission due to rapidly progressive acute lung injury or acute respiratory distress syndrome, and the median time from arrival at the hospital to death was only 4 h and 20 min. When clinicians observe intravascular hemolysis in blood samples from patients with characteristic symptoms of MIH, they should prepare for a severe disease outcome. The underlying pathophysiology of fulminant cases must be investigated., (© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)
- Published
- 2022
- Full Text
- View/download PDF
44. Clinical Presentations, Predictive Factors, and Outcomes of Clostridioides difficile Infection among COVID-19 Hospitalized Patients—A Single Center Experience from the COVID Hospital of the University Clinical Center of Vojvodina, Serbia
- Author
-
Kovačević N, Lendak D, Popović M, Plećaš Đuric A, Pete M, Petrić V, Sević S, Tomić S, Alargić J, Damjanov D, Kosjer D, and Lekin M
- Subjects
- Aged, Albumins, Anti-Bacterial Agents therapeutic use, Diarrhea epidemiology, Diarrhea etiology, Hospitals, Humans, Retrospective Studies, Serbia epidemiology, Universities, Yugoslavia, COVID-19 complications, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections drug therapy, Clostridium Infections epidemiology, Coinfection epidemiology
- Abstract
Background : This study aimed to investigate the clinical form, risk factors, and outcomes of patients with COVID-19 and Clostridioides difficile co-infections. Methods : This retrospective study (2 September 2021-1 April 2022) included all patients with Clostridioides difficile infection (CDI) and COVID-19 infection who were admitted to the Covid Hospital of the University Clinical Center of Vojvodina. Results : A total of 5124 COVID-19 patients were admitted to the Covid Hospital, and 326 of them (6.36%) developed hospital-onset CDI. Of those, 326 of the CDI patients (88.65%) were older than 65 years. The median time of CDI onset was 12.88 days. Previous hospitalizations showed 69.93% of CDI patients compared to 38.81% in the non-CDI group ( p = 0.029). The concomitant antibiotics exposure was higher among the CDI group versus the non-CDI group (88.65% vs. 68.42%, p = 0.037). Albumin levels were ≤ 25 g/L among 39.57% of the CDI patients and 21.71% in the non-CDI patients ( p = 0.021). The clinical manifestations of CDI ranged from mild diarrhea (26.9%) to severe diarrhea (63.49%) and a complicated form of colitis (9.81%). Regarding outcomes, 79.14% of the CDI patients recovered and 20.86% had fatal outcomes in-hospital. Although a minority of the patients were in the non-CDI group, the difference in mortality rate between the CDI and non-CDI group was not statistically significant (20.86% vs. 15.13%, p = 0.097). Conclusions : Elderly patients on concomitant antibiotic treatments with hypoalbuminemia and with previous healthcare exposures were the most affected by COVID-19 and CD co-infections.
- Published
- 2022
- Full Text
- View/download PDF
45. Histological features of Clostridioides difficile colitis in patients with inflammatory bowel disease.
- Author
-
Sweeney JR, Crawford CV, and Yantiss RK
- Subjects
- Clostridioides, Humans, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections diagnosis, Colitis, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases pathology
- Abstract
Aims: Patients with inflammatory bowel disease (IBD) are at increased risk for Clostridioides difficile infection, although clinically important infections can be difficult to recognise. C. difficile infection does not produce pseudomembranes when it occurs in IBD patients. These individuals may also be colonised by the organism, in which case diarrhoeal symptoms are not necessarily attributed to C. difficile. We performed this study to determine whether any features distinguished C. difficile-associated colitis from an IBD flare., Methods and Results: We reviewed the clinical, endoscopic and biopsy findings from 50 patients with established IBD and worsening diarrhoea, including 22 with concurrent positive C. difficile stool toxin polymerase chain reaction (PCR) assays and 28 with negative C. difficile assay results. We found that C. difficile-infected patients had symptoms and endoscopic findings that were indistinguishable from active IBD. Although most biopsy samples from patients with C. difficile infection showed chronic active colitis indistinguishable from IBD, some displayed neutrophilic infiltrates unaccompanied by plasma cell-rich inflammation involving superficial (41%) and crypt (18%) epithelium as well as neutrophilic infiltrates within lamina propria distant from foci of cryptitis (32%). All three of these features were significantly more common among infected than uninfected patients (4, 0 and 4%; P = 0.002, P = 0.03 and P = 0.02, respectively)., Conclusions: Although colonic biopsies from IBD patients with C. difficile infection usually lack features that aid distinction from colitic flares, some cases show an acute colitis pattern not seen in IBD alone. When identified in biopsies from symptomatic IBD patients, these changes should alert pathologists to the possibility of this clinically important infection., (© 2022 John Wiley & Sons Ltd.)
- Published
- 2022
- Full Text
- View/download PDF
46. Fecal microbiota transplantation can improve cognition in patients with cognitive decline and Clostridioides difficile infection.
- Author
-
Park SH, Lee JH, Kim JS, Kim TJ, Shin J, Im JH, Cha B, Lee S, Kwon KS, Shin YW, Ko SB, and Choi SH
- Subjects
- Aged, Aged, 80 and over, Anti-Bacterial Agents therapeutic use, Cognition, Fecal Microbiota Transplantation, Feces microbiology, Female, Humans, Treatment Outcome, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections microbiology, Clostridium Infections therapy, Cognitive Dysfunction therapy, Dementia
- Abstract
After fecal microbiota transplantation (FMT) to treat Clostridioides difficile infection (CDI), cognitive improvement is noticeable, suggesting an essential association between the gut microbiome and neural function. Although the gut microbiome has been associated with cognitive function, it remains to be elucidated whether fecal microbiota transplantation can improve cognition in patients with cognitive decline. The study included 10 patients (age range, 63-90 years; female, 80%) with dementia and severe CDI who were receiving FMT. Also, 10 patients (age range, 62-91; female, 80%) with dementia and severe CDI who were not receiving FMT. They were evaluated using cognitive function tests (Mini-Mental State Examination [MMSE] and Clinical Dementia Rating scale Sum of Boxes [CDR-SB]) at 1 month before and after FMT or antibiotics treatment (control group). The patients' fecal samples were analyzed to compare the composition of their gut microbiota before and 3 weeks after FMT or antibiotics treatment. Ten patients receiving FMT showed significantly improvements in clinical symptoms and cognitive functions compared to control group. The MMSE and CDR-SB of FMT group were improved compare to antibiotics treatment (MMSE: 16.00, median, 13.00-18.00 [IQR] vs. 10.0, median, 9.8-15.3 [IQR]); CDR-SB: 5.50, median, 4.00-8.00 [IQR]) vs. 8.0, median, 7.9-12.5, [IQR]). FMT led to changes in the recipient's gut microbiota composition, with enrichment of Proteobacteria and Bacteroidetes . Alanine, aspartate, and glutamate metabolism pathways were also significantly different after FMT. This study revealed important interactions between the gut microbiome and cognitive function. Moreover, it suggested that FMT may effectively delay cognitive decline in patients with dementia.
- Published
- 2022
- Full Text
- View/download PDF
47. Association Between Immunosuppressive Therapy and Outcome of Clostridioides difficile Infection: Systematic Review and Meta-Analysis.
- Author
-
Li Y, Cai H, Sussman DA, Donet J, Dholaria K, Yang J, Panara A, Croteau R, and Barkin JS
- Subjects
- Adult, Hospitalization, Humans, Immunosuppression Therapy, Risk Factors, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections drug therapy, Clostridium Infections epidemiology
- Abstract
Background: Patients with Clostridioides difficile infection (CDI) often have coexisting medical problems requiring immunosuppressive therapy. However, limited data are available on the association between immunosuppressive therapy and CDI outcomes., Aim: To determine the association between immunosuppressive therapy and CDI outcomes., Methods: PubMed, Embase, and Cochrane Library were searched through February 2021. Two reviewers independently reviewed and included studies that compared adult CDI patients who received immunosuppressive therapy to those who did not. The primary outcome was complicated CDl, including death, surgery, shock, or ICU admission. Raw data or unadjusted odds ratios (ORs) were used to calculate pooled ORs with 95% confidence intervals (CIs)., Results: Twenty-two studies with a total of 5759 CDI patients were selected. Immunosuppressive therapy was significantly associated with both primary outcome and death, with pooled ORs of 1.61 (95% CI 1.33-1.96) and 1.73 (95% CI 1.39-2.15) separately. The association between corticosteroids and primary outcome was also significant with OR of 1.73 (95% CI 1.41, 2.12). In subgroup analysis, the factors explaining differences in study results included study quality, patient age, and whether individual studies had adjusted for potential confounders. In a systematic review, most studies suggested a positive association between immunosuppressive therapy and complicated outcomes of CDI in patients comorbid for IBD., Conclusions: Our systematic review and meta-analysis demonstrate that immunosuppressive therapy is a risk factor for complicated outcomes of CDI., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Published
- 2022
- Full Text
- View/download PDF
48. Successful Treatment of Concomitant Colitis and Bacteremia Due to Clostridioides Difficile .
- Author
-
Yates JR, Brown SR, Vincent S, Leatherwood MS, and Grant JM
- Subjects
- Clostridioides, Humans, Bacteremia complications, Bacteremia drug therapy, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections drug therapy, Colitis complications, Colitis drug therapy
- Published
- 2022
- Full Text
- View/download PDF
49. Venous sinus thrombosis secondary to disseminated intravascular coagulation after Clostridioides difficile infection.
- Author
-
Alba Isasi MT, García Núñez DF, Navarro García JC, and Valero López G
- Subjects
- Humans, Clostridium Infections complications, Disseminated Intravascular Coagulation complications, Sinus Thrombosis, Intracranial complications, Sinus Thrombosis, Intracranial etiology
- Published
- 2022
- Full Text
- View/download PDF
50. Efficacy and Outcomes of Faecal Microbiota Transplantation for Recurrent Clostridioides difficile Infection in Children with Inflammatory Bowel Disease.
- Author
-
Nicholson MR, Alexander E, Ballal S, Davidovics Z, Docktor M, Dole M, Gisser JM, Goyal A, Hourigan SK, Jensen MK, Kaplan JL, Kellermayer R, Kelsen JR, Kennedy MA, Khanna S, Knackstedt ED, Lentine J, Lewis JD, Michail S, Mitchell PD, Oliva-Hemker M, Patton T, Queliza K, Sidhu S, Solomon AB, Suskind DL, Weatherly M, Werlin S, de Zoeten EF, and Kahn SA
- Subjects
- Adult, Child, Chronic Disease, Fecal Microbiota Transplantation adverse effects, Feces, Humans, Recurrence, Treatment Outcome, Clostridioides difficile, Clostridium Infections complications, Clostridium Infections therapy, Inflammatory Bowel Diseases complications, Inflammatory Bowel Diseases therapy
- Abstract
Background: Children with inflammatory bowel disease [IBD] are disproportionally affected by recurrent Clostridioides difficile infection [rCDI]. Although faecal microbiota transplantation [FMT] has been used with good efficacy in adults with IBD, little is known about outcomes associated with FMT in paediatric IBD., Methods: We performed a retrospective review of FMT at 20 paediatric centres in the USA from March 2012 to March 2020. Children with and without IBD were compared with determined differences in the efficacy of FMT for rCDI. In addition, children with IBD with and without a successful outcome were compared with determined predictors of success. Safety data and IBD-specific outcomes were obtained., Results: A total of 396 paediatric patients, including 148 with IBD, were included. Children with IBD were no less likely to have a successful first FMT then the non-IBD affected cohort [76% vs 81%, p = 0.17]. Among children with IBD, patients were more likely to have a successful FMT if they received FMT with fresh stool [p = 0.03], were without diarrhoea prior to FMT [p = 0.03], or had a shorter time from rCDI diagnosis until FMT [p = 0.04]. Children with a failed FMT were more likely to have clinically active IBD post-FMT [p = 0.002] and 19 [13%] patients had an IBD-related hospitalisation in the 3-month follow-up., Conclusions: Based on the findings from this large US multicentre cohort, the efficacy of FMT for the treatment of rCDI did not differ in children with IBD. Failed FMT among children with IBD was possibly related to the presence of clinically active IBD., (© The Author(s) 2021. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
- Published
- 2022
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.